Contraception and Family Planning Practice Questions

Q: Which of the following is an adverse effect of combined oral contraceptive pills?

Liver disorders. **Explanation:** Combined Oral Contraceptive Pills (COCPs) contain both estrogen and progestogen. Their metabolic impact on the liver is a significant clinical consideration. **Why Liver Disorders is Correct:** The estrogen component (usually ethinylestradiol) in COCPs is metabolized in the liver. It can induce hepatic enzymes, alter bile composition, and decrease bile flow, leading to **cholestatic jaundice**. Long-term use is also strongly associated with **Hepatic Adenomas** (benign but vascular tumors). Therefore, COCPs are strictly contraindicated in patients with active liver disease, cirrhosis, or a history of cholestasis of pregnancy. **Analysis of Incorrect Options:** * **Pelvic Inflammatory Disease (PID):** COCPs actually **decrease** the risk of PID. The progestogen component thickens the cervical mucus, creating a physical barrier that prevents the upward migration of pathogens into the upper reproductive tract. * **Weight Loss:** Weight changes are a common concern, but COCPs are more frequently associated with minor **weight gain** due to fluid retention (estrogen) or increased appetite (progestogen), though large-scale studies show this effect is often negligible. * **Acne:** COCPs are a **treatment** for acne, not a cause. They increase Sex Hormone Binding Globulin (SHBG), which lowers free testosterone levels, thereby reducing sebum production. **High-Yield NEET-PG Pearls:** * **Cancer Risks:** COCPs **increase** the risk of Breast and Cervical cancer but are **protective** against Ovarian and Endometrial cancer (the "Rule of 2": 10 years of use reduces risk by 50% for 20 years). * **Cardiovascular:** The most serious acute side effect is **Venous Thromboembolism (VTE)** due to increased clotting factors (VII, X, and Fibrinogen). * **Absolute Contraindication:** Smokers >35 years of age (due to high risk of MI and stroke).

Q: The combined oral contraceptive pill is absolutely contraindicated in:

History of thromboembolism. **Explanation:** The **Combined Oral Contraceptive Pill (COCP)** contains estrogen, which increases the hepatic synthesis of clotting factors (II, VII, IX, and X) and decreases anticoagulant levels (Protein S and Antithrombin III). This induces a hypercoagulable state. **1. Why Option A is Correct:** A **history of thromboembolism** (DVT or Pulmonary Embolism) is a **WHO Medical Eligibility Criteria (MEC) Category 4** contraindication (absolute contraindication). Since the estrogen component significantly elevates the risk of recurrent thrombotic events, COCPs are strictly prohibited in these patients. **2. Why the other options are incorrect:** * **B. Pelvic Inflammatory Disease (PID):** COCPs are not contraindicated in PID. In fact, they may offer a protective effect by thickening cervical mucus, which prevents the upward migration of pathogens. * **C. Age above 40 years:** Age alone is not a contraindication. However, it becomes a contraindication if combined with smoking (≥15 cigarettes/day) or other cardiovascular risk factors. * **D. Leiomyoma:** COCPs are not contraindicated and are often used to manage the heavy menstrual bleeding associated with fibroids. **NEET-PG High-Yield Pearls:** * **Absolute Contraindications (MEC 4):** Undiagnosed vaginal bleeding, pregnancy, history of thromboembolism, stroke, ischemic heart disease, active liver disease/tumors, breast cancer, and smokers >35 years old (≥15 cigarettes/day). * **Best Contraceptive for a Lactating Mother:** Progesterone-only pills (POPs) or Centchroman (Saheli), as estrogen suppresses lactation. * **Non-contraceptive benefit:** COCPs reduce the risk of Ovarian and Endometrial cancers.

Q: What is the best index for measuring the efficacy of contraception?

Life Table Analysis. ### Explanation The efficacy of a contraceptive method is measured by its failure rate. While multiple indices exist, **Life Table Analysis** is considered the superior and most accurate method. **1. Why Life Table Analysis is the Correct Answer:** Unlike other methods, Life Table Analysis calculates the **cumulative failure rate** at specific intervals (e.g., 12, 24, or 36 months). It accounts for "loss to follow-up" and varying durations of use among participants. By calculating the probability of pregnancy for each month of use, it provides a more scientifically rigorous and longitudinal view of contraceptive effectiveness compared to a simple ratio. **2. Analysis of Incorrect Options:** * **Pearl Index (Option A):** This is the most *commonly* used index, but not the *best*. It is defined as the number of unintended pregnancies per 100 woman-years of exposure. Its main drawback is that it assumes a constant failure rate over time, whereas, in reality, the risk of failure is highest in the first few months of use and decreases over time. * **Couple Protection Rate (Option C):** This is a **process indicator** used by national family planning programs to monitor the proportion of eligible couples protected by any modern contraceptive method. It measures program coverage and prevalence, not the clinical efficacy of a specific contraceptive. **3. NEET-PG High-Yield Pearls:** * **Pearl Index Formula:** (Total Accidental Pregnancies × 1200) / (Total months of exposure). * **Most Effective Contraceptive:** Implants (Etonogestrel) have the lowest Pearl Index (~0.05). * **Hierarchy of Efficacy:** Life Table Analysis > Pearl Index. * **Contraceptive Prevalence Rate (CPR):** The percentage of currently married women (15-49 years) who are using any method of contraception. In India (NFHS-5), the CPR is approximately 67%.

Q: Which of the following drugs cannot be used for Medical Termination of Pregnancy (MTP) in a patient with bronchial asthma?

Prostaglandin. ### Explanation **Correct Option: A. Prostaglandin** Prostaglandins, specifically **Prostaglandin F2-alpha (PGF2α)** and its analogues (like Carboprost), are potent **bronchoconstrictors**. In patients with bronchial asthma, these drugs can trigger severe bronchospasm and life-threatening asthma attacks. While Misoprostol (PGE1) is more commonly used for MTP and has a weaker effect on the bronchi, the entire class of prostaglandins is generally avoided or used with extreme caution in asthmatics if safer alternatives exist. **Analysis of Incorrect Options:** * **B. Oxytocin:** This is a posterior pituitary hormone used for induction of labor and preventing PPH. It acts specifically on uterine smooth muscle and has no significant effect on bronchial smooth muscle, making it safe for asthmatics. * **C. Mifepristone:** This is an anti-progestational steroid. It works by blocking progesterone receptors to cause decidual breakdown and cervical softening. It does not interact with the respiratory system and is the first-line drug for medical MTP. * **D. Ethacrydine:** This is an abortifacient used for second-trimester MTP via extra-amniotic instillation. It acts as a local irritant to induce contractions and does not cause bronchoconstriction. **Clinical Pearls for NEET-PG:** * **Carboprost (PGF2α):** Specifically contraindicated in **Asthma**. * **Methylergometrine (Methergine):** Specifically contraindicated in **Hypertension** and Preeclampsia (causes vasoconstriction). * **Misoprostol (PGE1):** The most common prostaglandin used in MTP; it is safer than PGF2α but still used cautiously in severe asthmatics. * **MTP Act Update:** Medical MTP is highly effective up to **9 weeks (63 days)** of gestation using a combination of Mifepristone (200mg) and Misoprostol (800mcg).

Q: What are the contraindications for the use of an intrauterine contraceptive device (IUCD)?

Undiagnosed vaginal bleeding and PID. **Explanation:** The selection of an Intrauterine Contraceptive Device (IUCD) requires careful screening for contraindications to prevent complications like infection or delayed diagnosis of malignancy. **Why Option D is Correct:** According to the WHO Medical Eligibility Criteria (MEC), **Pelvic Inflammatory Disease (PID)** and **Undiagnosed Vaginal Bleeding** are Category 4 contraindications (unacceptable health risk). 1. **PID:** Inserting an IUCD during an active infection can exacerbate the condition and lead to pelvic sepsis or tubal damage. 2. **Undiagnosed Vaginal Bleeding:** This is a contraindication because the bleeding could be a symptom of an underlying malignancy (like endometrial or cervical cancer) or pregnancy. An IUCD must not be inserted until the cause is diagnosed and serious pathology is ruled out. **Analysis of Incorrect Options:** * **Options A & B:** While they mention undiagnosed bleeding and PID, Option D is the most complete representation of the standard contraindications listed in the question context. * **Option C:** **Obesity** is not a contraindication for IUCD use. In fact, LARC (Long-Acting Reversible Contraception) like the IUCD or LNG-IUS is often preferred for obese patients as it avoids the metabolic risks associated with combined oral contraceptives. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications (MEC 4):** Pregnancy, active PID, undiagnosed vaginal bleeding, distorted uterine cavity (large fibroids), and current copper allergy (for Cu-T). * **Wilson’s Disease:** A specific contraindication for Copper-T, but not for the Levonorgestrel-releasing system (Mirena). * **Timing:** The best time for insertion is during menstruation or within 10 days of the cycle to ensure the patient is not pregnant and the cervix is slightly dilated. * **Ideal Candidate:** A parous woman in a stable monogamous relationship (low risk of STIs/PID).

Q: Which of the following statements about Nova T is true?

Silver core. **Explanation:** **Nova T** is a second-generation copper-releasing intrauterine device (IUCD). The correct answer is **D (Silver core)** because the copper wire of Nova T contains a **silver core**. This design is specifically engineered to prevent the fragmentation of the copper wire, thereby increasing the device's durability and ensuring a steady release of copper ions over time. **Analysis of Options:** * **A. Effective for 10 years:** This is incorrect. Nova T is typically effective for **5 years**. The Cu-T 380A is the device famously known for its 10-year lifespan. * **B. More copper content:** This is incorrect. Nova T has a surface area of **200 $mm^2$** of copper. In contrast, the Cu-T 380A has significantly more copper (380 $mm^2$). * **C. More chances of perforation:** This is incorrect. The risk of uterine perforation (approx. 1 in 1000 insertions) is generally consistent across standard IUCDs and depends more on the provider's technique and the timing of insertion (e.g., postpartum) rather than the specific design of Nova T. **High-Yield Clinical Pearls for NEET-PG:** * **The Silver Advantage:** The silver core prevents "pitting" or corrosion of the copper wire, which was a common issue in older models. * **Surface Area Comparison:** * **Nova T / Cu-T 200:** 200 $mm^2$ (5 years) * **Cu-T 380A:** 380 $mm^2$ (10 years - Gold Standard) * **Multiload 375:** 375 $mm^2$ (5 years) * **Ideal Candidate:** IUCDs are best suited for parous women in stable monogamous relationships. * **Most Common Side Effect:** Bleeding (Menorrhagia) is the most common reason for removal, followed by pain.

Question 1

Which of the following is an adverse effect of combined oral contraceptive pills?

Accepted Answer

Liver disorders

Answer

Pelvic inflammatory disease (PID)

Answer

Weight loss

Answer

Acne

Question 2

The Yuzpe method is used for which of the following contraceptive techniques?

Accepted Answer

Emergency contraception with oral contraceptive pills (OCPs)

Answer

Sterilization using the 'No scalpel technique'

Answer

Emergency contraception with intrauterine devices (IUDs)

Answer

Evaluation of newer contraceptive methods

Question 3

A 23-year-old woman desires a combined oral contraceptive for pregnancy protection. Which of the following factors would lead a health professional to recommend an alternative form of contraception?

Accepted Answer

History of migraine headache that is well controlled by sumatriptan

Answer

Evidence of hirsutism

Answer

Presence of fibroids

Answer

History of pelvic inflammatory disease

Question 4

The combined oral contraceptive pill is absolutely contraindicated in:

Accepted Answer

History of thromboembolism

Answer

Pelvic inflammatory disease

Answer

Age above 40 years

Answer

Leiomyoma

Question 5

What is the best index for measuring the efficacy of contraception?

Accepted Answer

Life Table Analysis

Answer

Pearl Index

Answer

Couple protection rate

Answer

None of the above

Question 6

A woman using oral contraceptive pills misses 3 pills during the third week of her cycle. What is the recommended course of action?

Accepted Answer

Finish only the remaining hormonal pills in the current pack and start a new pack the next day.

Answer

Continue taking the pills from the current pack.

Answer

Take all missed pills along with the next scheduled pill and continue the pack.

Answer

Start a new pack of oral contraceptive pills immediately.

Question 7

Which of the following drugs cannot be used for Medical Termination of Pregnancy (MTP) in a patient with bronchial asthma?

Accepted Answer

Prostaglandin

Answer

Oxytocin

Answer

Mifepristone

Answer

Ethacrydine

Question 8

What are the contraindications for the use of an intrauterine contraceptive device (IUCD)?

Accepted Answer

Undiagnosed vaginal bleeding and PID

Answer

Undiagnosed vaginal bleeding

Answer

Undiagnosed vaginal bleeding and obesity

Question 9

Which of the following statements about Nova T is true?

Accepted Answer

Silver core

Answer

Effective for 10 years

Answer

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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